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The prognostic value of including non‐alcoholic fatty liver disease in the definition of metabolic syndrome

Fu, Clarissa Elysia; Yong, Jie Ning; Ng, Cheng Han; Nah, Benjamin; Chew, Nicholas W. S.; Chin, Yip Han; Kong, Gwyneth; Tan, Darren Jun Hao; Lim, Wen Hui; Lim, Lincoln Kai En; Zeng, Rebecca Wenling; Shabbir, Asim; Tan, Eunice X. X.; Huang, Daniel Q.; Khoo, Chin Meng; Siddqui, Mohammad Shadab; Chan, Mark Y. Y.; Noureddin, Mazen; Mamas, Mamas A.; Muthiah, Mark


Clarissa Elysia Fu

Jie Ning Yong

Cheng Han Ng

Benjamin Nah

Nicholas W. S. Chew

Yip Han Chin

Gwyneth Kong

Darren Jun Hao Tan

Wen Hui Lim

Lincoln Kai En Lim

Rebecca Wenling Zeng

Asim Shabbir

Eunice X. X. Tan

Daniel Q. Huang

Chin Meng Khoo

Mohammad Shadab Siddqui

Mark Y. Y. Chan

Mazen Noureddin

Mark Muthiah


Background/Aims Metabolic syndrome (MetS) affects over one third of the US adult population. Despite its close association with non-alcoholic fatty liver disease (NAFLD), the traditional definition of MetS does not account for the presence of NAFLD. The present study thus aims to evaluate the inclusion of NAFLD in the diagnostic criteria of metabolic syndrome on its accuracy of capturing individuals with metabolic dysregulation and its prediction of adverse events. Methods Data collected from NHANES between 1999 and 2018 was analysed. Clinical characteristics and outcomes between individuals with metabolic syndrome from both the American Heart Association/National Heart, Lung, and Blood Institute (MetS) and the study's proposed diagnostic criteria (MetS2) were evaluated. Outcomes in both groups were evaluated with multivariate analyses, and further subgroup analysis on individuals matched with Coarsened Exact Matching was performed. Results Of 46,184 individuals included, 32.54% and 40.54% fulfilled MetS and MetS2 criteria respectively. Considering NAFLD in the definition of metabolic syndrome, a further 8.00% (n = 3694) were included. MetS was significantly associated with all-cause (HR: 1.184, 95% CI: 1.110–1.263, p?<?0.001) and cardiovascular disease (CVD) mortality (SHR: 1.288, 95% CI: 1.233–1.347, p?<?0.001), and major adverse cardiovascular events (MACE). MetS2 was similarly associated with all-cause (HR: 1.175, 95% CI: 1.088–1.269, p?<?0.001), CVD mortality (SHR: 1.283, 95% CI: 1.245–1.323, p?<?0.001) and MACE. Conclusion Inclusion of NAFLD allows for identification a greater proportion of the population with metabolic risk. This allows for early intervention and potential to lift some burden off the global healthcare system.

Journal Article Type Article
Acceptance Date Jan 8, 2023
Online Publication Date Jan 29, 2023
Publication Date May 1, 2023
Journal Alimentary Pharmacology &amp; Therapeutics
Print ISSN 0269-2813
Publisher Wiley
Volume 57
Issue 9
Pages 979-987
Keywords Pharmacology (medical), Gastroenterology, Hepatology
Publisher URL